DEFINITION OF TERMS
ante - before
antepartum - time before delivery
prenatal - time before death
gravida - any pregnancy regardless of duration, including the present one
nulligravida - women who has never been pregnant
para - number of births after 20 weeks gestation regardless of whether the infants were born alive
or dead (multifetal pregnancies are considered single para)
primigravida - pregnant for the first time
multigravida - a woman who is in her second or subsequent pregnancy
nullipara - woman who has not given birth at more than 20 weeks gestation
primipara - woman who has given birth to a fetus (dead or alive) that has reached 20 weeks gestation
multipara - woman who has given birth two or more times at more than 20 weeks gestation
still birth - fetus born dead after 20 weeks gestation
abortion - pregnancy that terminates before the fetus reaches 20 weeks but before full term
post-term birth - pregnancy that terminates 2 weeks after the expected date of birth or 42 weeks of
gestation
OBSTETRIC HISTORY
GTPALM
- method that is commonly used for recording (using symbols) a woman's pregnancy history
- provides a systematic, quick system to indicate not only the number of pregnancies the
woman has had but also the outcomes, which can be shown using a shorthand method
G - gravida
T - term pregnancies
P - premature births
A - abortions
L - number of living children
M - multiple gestations
Example:
A pregnant woman who has 4 living children all single births, and who has had no preterm births and no abortions.
GTPALM: 5-4-0-0-4-0
DETERMINATION OF DATE OF BIRTH
Naegels' Rule - method for obtaining an estimated date of delivery
To calculate:
a. Identify the last normal menstrual period
b. Count backwards 3 months
c. add 7 days
Example:
LNMP : October 18
EDB : July 25
The average duration of pregnancy is approximately 280 days. This period is calculated in 28-day months called lunar months. 10 lunar months (40 weeks, 280 days) in a full-term pregnancy.
SIGNS OF PREGNANCY
1. Presumptive - may suggest pregnancy
2. Probable - woman is likely pregnant
3. Positive - gives definite evidence that the woman is pregnant
Presumptive Signs of Pregnancy
- nausea and vomiting
- urinary frequency
- fatigue (may be excessive)
- breast tenderness and changes
- uterine enlargement
- quickening: feels tight, fluttery movements of fetus, at about 18-20 weeks of pregnancy usually
caused by gas movements within bowel or increased peristalsis
Probable Signs of Pregnancy
Uterine enlargement
Linea Negra - changes in skin pigmentation that appears on the abdomen, nipples and areola of the
breast caused by hormonal increase
Goodell's Sign - softening of the cervix
Hegar's Sign - softening of the lower portion of the uterus
Chadwick's Sign - bluish-purple discoloration of vaginal mucous membrane
Piskacek's Sign - enlargement and softening of the uterus
Ballottement - reboundign of fetus in amniotic fluid felt by examiner during pelvic examination
Braxton-Hick's Contraction - painless, irregular uterine contractions, felt by women as tightening across
the abdomen
Positive pregnancy tests - presence of hCG in the uterine/plasma
Uterine souffle - soft, blowing murmur auscultated over the uterus after 4th month of pregnancy
Positive Signs of Pregnancy
1. Fetal heart sounds heard
- audible at 10-12 weeks gestation through Doppler UTZ
- audible at 16-20 weeks gestation by fetoscope
- normal FHR: 120-160 bpm
2. Fetal movements palpated by examiner
3. Fetal outline visualized by ultrasound
REPRODUCTIVE SYSTEM CHANGES OF PREGNANCY
a. Uterus
- increase in length, width, depth, weight and volume
- Braxton-Hick's contraction occurs intermittently throughout pregnancy and can be felt by the
woman by the 4th month
- after 20 weeks' gestation, fundal height in centimeters approximates the weeks of pregnancy
up to 36 weeks
b. Cervix
- stimulated by estrogen, becomes vascular and edematous
- endocervical glands secrete thick mucous plug which seals the endocervical canal and
prevents contamination
- Goodell: softening of the cervix, results from cervical vascularization
c. Ovaries
- do not produce ova
- corpus luteum produces hormones (estrogen and progesterone) for the first 16 weeks of
pregnancy and then decrease in size
d. Vagina and External Genitalia
- increase vascularization causes tissue to thicken and soften
- vaginal discharge tends to be thick, white and acidic
e. Breasts
- increase in size and becomes more nodular due to glandular hyperplasia and hypertrophy
- nipple and areola darken, superficial veins become more prominent
- colostrum may leak or be expressed from the breast during the last 3 months of pregnancy
striae - stretch marks
colostrum - thin, pale, yellow, serous fluid excreted in the breasts during the first few days after
parturition
RESPIRATORY SYSTEM CHANGES
- diaphragm elevates and the substernal angle increases due to an enlarging uterus
- displacement causes shortness of breath
- increase RR by about 20 cpm
CARDIOVASCULAR SYSTEM CHANGES
- heart is displaced upward to the left and forward
- as the uterus enlarges, pressure on blood vessels increase and slows circulation which may
lead to edema and/or varicosities of the legs, vulva and rectum
- pressure of the enlarged uterus on the vena cava causes supine HPN syndrome during 2nd tri
GASTROINTESTINAL SYSTEM CHANGES
- gastric acidity decreases
- heartburn and flatulence may also be manifested due to decreased gastric acidity
- bloating and constipation may occur due to delayed gastric emptying and decreased intestinal
motility
URINARY SYSTEM CHANGES
- urine output increases while urine specific gravity decreases
- urinary stasis and UTI may occur due to pressure on the ureters and urethra from the growing
fetus
- bladder capacity increases to 1500 mL
- urinary frequency occurs in the first and third trimester dues to pressure from enlarged uterus
INTEGUMENTARY SYSTEM CHANGES
- pigmentation changes occur in the areola, nipple, abdomen, thighs and vulva
- facial chloasma (mask of pregnancy) and vascular spider nevi may develop
- activity of sebaceous and sweat glands may increase
SKELETAL SYSTEM CHANGES
- symphysis pubis may separate
- lumbodorsal spine curve is increased during the third trimester commonly producing low back
pain
- lordotic posture is evident (pride of pregnancy)
METABOLIC CHANGES
- accelerate to 20%
- average weight gain is 24-30 lbs
- increase water retention during pregnancy to support the increase in blood volume and to serve
as a ready source of nutrients for the fetus
ENDOCRINE SYSTEM CHANGES
- rise in thyroxine (T4)
- increase parathyroid hormone production
- APG increases secretion of prolactin, responsible for lactation
- PPG releases oxytocin, producing uterine contraction
- PPG releases oxytocin and vasopressin to promote vasoconstriction
- pancreas increases production of insulin
- placenta is the endocrine gland of pregnancy, secretes hormones of pregnancy - hCG, estrogen,
progesterone, hPL and relaxin
RSS Feed